Roy’s Adaptation Model (RAM) is a conceptual model that facilitates nurses’ assessment, direct research, and promotes education. It is concentrated on people’s adaptation to changeable environment and used as a reference for nursing assessment. RAM assists nurses’ abilities to improve personal interactions with their immediate surroundings. RAM promotes holistic health to persons by assisting the individual to adapt to their environment. She recommended the nurse to utilize a consistent nurse process.
The Roy Adaptation Model was developed by Sister Callista Roy who was born in Los Angeles, California in 1939. She earned her baccalaureate degree in nursing in 1936 from Mount Saint Mary’s College. She then continued her education and pursued her masters in nursing and sociology in 1966 and 1973 respectively. In 1977 she obtained her doctorate in sociology in 1977 from the University of California. She developed the adaptation model after being challenged by Dorothy Johnson in a seminar to come up with a nursing model. As a result Roy’s model was published in 1970.
According to Webster’s dictionary adaptation is defined as adjusting oneself to different condition and environment. Adaptation has resulted in optimal health and well- being to quality of life and death with dignity (Andrew and Roy, 1991). Roy has described three levels: integrated, compensatory, and compromise life process. The levels are integrated in some situations. Life process becomes a compensatory process which strives to maintain adaptation. When the compensatory process is not enough a compromised process results.
The coping process in RAM consists of an innate and acquired coping mechanism. Innate coping mechanism and is an inherited quality through genetics and is pre-determined. Acquired coping mechanism is learned and developed by customary response. Roy has further categorized the process of coping by explaining the differences between regulatory and cognatory as they refer to individuals. The stabilizer and innovator sub categories are referred to as groups. The regulatory sub system reacts through neural, chemical, and endocrine coping channels. People pick up stimuli from their internal and external environments which are processed by the nervous system. These reactions can affect fluid, electrolytes, acid- base balance, and the endocrine system. The information is processed automatically by bio-feedback producing automatic unconscious response.
The next adaptive process, the cognitive process reacts by four cognitive emotional channels. It includes perceptual, informational processing, learning, judgment, and emotions. Perceptual and informational consists of activities such as selective attention coding and memory. The learning aspect focuses on reinforcement, imitation, and insight. While judgment involves problem solving and decision making.
The cognator and stabilizer innovator subsystem functions to balance the integrated life process. Coping is not seen but the behavior can be observed and measured.
In spite of recognizing specific processes inherited by the regulator- congnator system it is not clear to see the function of the system. Therefore, the behavior can be grouped into four distinct categories or adaptive modes. They are physical mode, self-concept group identify modes, role function mode, and independence mode. Through these modes various observations are made such as reaction and interaction with the environment and the adaptation to the surroundings.
Physiological or physical mode deals with physiologic activities in the human body. It consists of the cell, tissue organs, and different body’s system. There are five basic needs, oxygenation, nutrition, elimination, activity, rest, and protection. The four process processes included in physiological adaptation is the sense, fluid- electrolyte acid base balance, neurologic function, and endocrine function. The underlying need for physiological mode is physiologic integrity (page 43). It is important that the group has physical resources so they can utilize it for adaptation.
Self-concept group identifier mode compromises of one physical self that includes body sensations and the body image. Personal self includes self-consistency, self-ideals, moral, ethical, and spiritual self. The fundamental need of self-concept is maintaining mental and spiritual integrity, and the need to understand self. On the other hand groups have interpersonal relationships such as groups of image, social milieu, culture, and shared responsibilities. The fundamental goal of the group is to maintain its identity’s integrity.
The role function mode concentrates on the individual’s role in society and the roles in a group. The basic principal is maintaining social integrity and the need to know one’s relationship with others.
The interdependence mode is associated with relationships depending on others. This mode concentrates on interactions intertwined with sharing love, respect, and values. The foundation of this mode is relation integrity and feeling secure in a nurturing relationship. It depends on two relationships that consist of significant others and supportive systems.
Roy has identified four metaparadigm concepts of nursing. They consist of person, environment, health, and nursing. According to RAM humans are holistic adaptive systems. The body is comprised of many parts which work together for a specific purpose. In the human system it consists of people as individuals, groups as families and organizations, and communities and society. In nursing the major recipient of care is the person. “The person is specifically as an adaptive system with cognator and regulator subsystems acting to maintain adaptation in four adaptive modes” (Roy 2009, p 12). The second model is the environment that involves internal and external surroundings of humans in the adaptive system. The environment includes all conditions and situations that influence the behavior of a person or group. The change in an environment shows different reaction and adjustment to the environment for the individual to maintain homeostasis. There are three factors which influence change in an environment they are focal, contextual, and residual stimuli. Focal stimuli are the immediate challenge confronted by the individual. Contextual stimuli are all the other indirect stimuli that affect the focal stimuli. Residual stimuli are all the factors within or outside the human stimuli. The effects on the focal stimuli are unclear.
Health is “the state and process of being and becoming integrated as a whole that reflects the person and the environment mutually” (Roy 2009, p.12). Over the years Roy’s perspective to health has change. In previous writing she wrote health as an existing along the continuum. She now views the conceptualization of health as “simplistic and unrealistic” due to the fact it did not consider the coexistence of wellness and illnesses. It exempted people who chronic illnesses and terminal diseases who were coping with their challenges adequately. During the 1990s Roy’s perspective focuses on health as a process in which health and wellness occurs simultaneously.
Roy defines nursing “as a health care profession that focuses on human life process and patterns of people with commitment to promote health and full life potentials for individuals, groups, families, and global society” (Roy 2009, p.3). She also defines nursing as a science and practice with the objectivity to promote adaptation for persons and groups through four adaptive modes impacting health, quality of life, and dying with dignity.
RAM is an important tool in the practice of nursing. It uses six steps to promote health and wellness. The initial step begins with assessing the behavior manifested from the four adaptive modes including physiological/physical mode, self-concept/group, role function mode and interdependence. Secondly it assesses and categorizes the stimuli for those behaviors. Thirdly nursing diagnosis is originated from the person’s adaptive state. Fourthly, the goals are set to promote adaptation. Fifthly, the plan of intervention focuses on managing the stimuli to foster adaptation. Finally, the nurse evaluates if the outcome is favorable or not favorable to adaptation. Roy emphasizes that these steps are listed separately but they are used together for the process to be accomplished.
Many researchers have attributed recognition for utilizing RAM. Studies of which RAM was applied as an organizational framework in guiding the studies. RAM was able to guide their work since it had the ability to integrate multiple adaptation modes for individuals despite their ages or conditions.

Reference
Master, K. (2011). Nursing Theories: A framework for professional practice. Sudbury, MA: Jones & Bartlett Learning, LLC.
Roy, Sr. C. (2009). The Roy adaptation model (3rd ed.).Upper Saddle River, NJ: Pearson.
Shosha, G. & Kalaldeh, M. (2012). A critical analysis of using Roy’s Adaptation Model in nursing research. International Journal of Academic Research, 4(4), 26-31. Doi:10.7813/2075-4124.2012/4-4/B.3